Tuberculosis among HIV-1-infected subjects in a tertiary out-patient service in São Paulo city, Brazil

Atualmente, a tuberculose (TB) é considerada a doença infecciosa mais importante entre os pacientes infectados pelo HIV-1 nos países em desenvolvimento, como o Brasil. Análise retrospectiva dos casos de tuberculose ocorridos a partir de janeiro 1995 até dezembro de 2010 foi realizada em nossa coorte de 599 pacientes HIV positivos. O desfecho primário foi a ocorrência de TB ativa, e 41 casos da doença foram diagnosticados durante este período de 16 anos. As contagens médias do nadir de células T CD4 e ao momento do diagnóstico de TB foram de 146 e 217 células/mm³, respectivamente. A carga viral média de HIV foi de 5,19 log10 cópias/mL, e 59% dos pacientes estavam em tratamento com ART. A incidência de TB foi de 1,47 casos por 100 pessoas-ano, para um tempo total de seguimento da coorte de 2775 pessoas-ano. A probabilidade de sobreviver até 10 anos após o diagnóstico foi de 75% para pacientes com TB, em oposição a 96% para pacientes com outras doenças oportunistas não-TB (p = 0,03). A tuberculose pode ser considerada problema de saúde pública entre as pessoas que vivem com HIV no Brasil, apesar da ampla utilização de anti-retrovirais para o tratamento da infecção pelo HIV / AIDS.TB is currently considered to be the most important infectious disease among HIV-1-infected subjects in developing countries, such as Brazil. A retrospective analysis of TB cases was performed, occurring from January 1995 to December 2010 in our cohort of 599 HIV positive patients. The primary outcome was the occurrence of active TB. Forty-one TB cases were diagnosed over this period of 16 years, among 599 HIV positive patients in an open cohort setting in the city of Sao Paulo, Brazil. All-time lowest mean CD4 T cell count at the time of TB diagnosis was 146 and 186 cells/mm³, respectively. The mean HIV viral load was 5.19 log10 copies/mL, and 59% of the patients were on HAART. TB incidence was 1.47 per 100 person-years, for a total follow-up time of 2775 person-years. The probability of surviving up to 10 years after diagnosis was 75% for TB patients as opposed to 96% for patients with other, non-TB opportunistic diseases (p = 0.03). TB can be considered a public health problem among people living with HIV in Brazil despite of the widespread use of antiretrovirals for the treatment of HIV infection/AIDS

DISCORDANCE BETWEEN BODY MASS INDEX AND ANTHROPOMETRIC MEASUREMENTS AMONG HIV-1-INFECTED PATIENTS ON ANTIRETROVIRAL THERAPY AND WITH LIPOATROPHY/LIPOHYPERTROPHY SYNDROME

Objetivos: A terapia antirretroviral altamente ativa (HAART) tem melhorado e aumentado a vida de milhares de pessoas que vivem com a infecção pelo HIV/AIDS em todo o mundo. No entanto, este tratamento pode levar ao desenvolvimento da síndrome da lipodistrofia (LDS). Este estudo foi desenvolvido para avaliar a prevalência de auto-relato de LDS, perfil nutricional e medidas antropométricas de pacientes com HIV/AIDS. Métodos: Estudo observacional de 227 pacientes adultos, divididos em: Grupo 1: 92 pacientes em HAART e com LDS; Grupo 2: 70 pacientes em tratamento com HAART e sem LDS e Grupo 3: 65 pacientes que não tomam HAART. O estado nutricional foi avaliado pelo índice de massa corporal (IMC) e o percentual de gordura corporal (%GC) por meio de medidas antropométricas. Resultados: A prevalência de auto-relato de LDS foi de 44% entre as mulheres e 39% entre os homens. DC do tríceps (PCT) apresentou-se mais elevada no grupo HAART e LDS (homens p < 0,001; mulheres p < 0,007) em comparação com aqueles sem HAART, respectivamente. IMC revelou excesso de peso para a maioria dos indivíduos. Conclusões: As medidas antropométricas foram úteis para confirmar a prevalência de auto-relato da síndrome da lipodistrofia. A avaliação das dobras dos braços e pernas revelou-se um bom método para avaliação antropométrica de lipoatrofia de membro, independentemente do sexo. Estes resultados permitiram o estabelecimento de estratégias para o diagnóstico precoce da LDS na prática clínica, em pessoas vivendo com HIV / AIDS.Introduction: Highly Active Antiretroviral Therapy (HAART) has improved and extended the lives of thousands of people living with HIV/AIDS around the world. However, this treatment can lead to the development of adverse reactions such as lipoatrophy/lipohypertrophy syndrome (LLS) and its associated risks. Objective: This study was designed to assess the prevalence of self-reported lipodystrophy and nutritional status by anthropometric measurements in patients with HIV/AIDS. Methods: An observational study of 227 adult patients in the Secondary Immunodeficiencies Outpatient Department of Dermatology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo (3002 ADEE-HCFMUSP). The sample was divided into three groups; Group 1 = 92 patients on HAART and with self-reported lipodystrophy, Group 2 = 70 patients on HAART without self-reported lipodystrophy and Group 3 = 65 patients not taking HAART. The nutritional status of individuals in the study sample was determined by body mass index (BMI) and percentage of body fat (% BF). The cardiovascular risk and diseases associated with abdominal obesity were determined by waist/hip ratio (WHR) and waist circumference (WC). Results: The prevalence of self-reported lipoatrophy/lipohypertrophy syndrome was 33% among women and 59% among men. Anthropometry showed depletion of fat mass in the evaluation of the triceps (TSF) in the treatment groups with HAART and was statistically independent of gender; for men p = 0.001, and for women p = 0.007. Similar results were found in the measurement of skin folds of the upper and lower body (p = 0.001 and p = 0.003 respectively). In assessing the nutritional status of groups by BMI and % BF, excess weight and body fat were more prevalent among women compared to men (p = 0.726). The WHR and WC revealed risks for cardiovascular and other diseases associated with abdominal obesity for women on HAART and with self-reported LLS (p = 0.005) and (p = 0.011). Conclusions: Anthropometric measurements were useful in the confirmation of the prevalence of LLS. BMI alone does not appear to be a good parameter for assessing the nutritional status of HIV-infected patients on HAART and with LLS. Other anthropometric measurements are needed to evaluate patients with the lipoatrophy/lipohypertrophy syndrome

Chemokine Receptors Expression on T Cells and Response to HAART Among Chronic HIV-1-Infected Subjects

Chemokines receptors are used by HIV-1 for entry into CD4(+) T cells. The chemokines are capable of inhibiting HIV replication. This study determined the CCR5 and CXCR4 expression on T cells in HIV-1-infected patients treated with HAART. The successfully treated group ( plasma viral load 400 copies/mL), when compared with the failure group ( plasma viral load >400 copies/mL), had higher median CD4+ T cells count ( 583 and 245 cells/mm(3); respectively, p<0.0001). The failure patients had higher numbers and intensity of CCR5 and CXCR4-expressing T cells. Successfully treated patients were able to normalize the co-receptors expression-over on T cells. The viremic group showed higher CCR5 expression on CD4+ T cells and lower number of cells; CCR5 expression was normalized in the aviremic group; the naive group showed lower CCR5 expression and higher numbers of CD4 T cells; all groups showed normal CXCR4 expression compared to healthy controls. These findings may have clinical implications, since down-regulation of these co-receptors could be an adjuvant strategy for anti-HIV treatment

Tuberculose entre pacientes infectados pelo HIV-1 em ambulatório\ud terciário de São Paulo, Brasil

TB is currently considered to be the most important infectious disease among HIV-1-infected subjects in developing countries, such as Brazil. A retrospective analysis of TB cases was performed, occurring from January 1995 to December 2010 in our cohort of 599 HIV positive patients. The primary outcome was the occurrence of active TB. Forty-one TB cases were diagnosed over this period of 16 years, among 599 HIV positive patients in an open cohort setting in the city of Sao Paulo, Brazil. All-time lowest mean CD4 T cell count at the time of TB diagnosis was 146 and 186 cells/mm3, respectively. The mean HIV viral load was 5.19 log10 copies/mL, and 59% of the patients were on HAART. TB incidence was 1.47 per 100 person-years, for a total follow-up time of 2775 person-years. The probability of surviving up to 10 years after diagnosis was 75% for TB patients as opposed to 96% for patients with other, non-TB opportunistic diseases (p = 0.03). TB can be considered a public health problem among people living with HIV in Brazil despite of the widespread use of antiretrovirals for the treatment of HIV infection/AIDS.Atualmente, a tuberculose (TB) é considerada a doença infecciosa\ud mais importante entre os pacientes infectados pelo HIV-1 nos países\ud em desenvolvimento, como o Brasil. Análise retrospectiva dos casos de\ud tuberculose ocorridos a partir de janeiro 1995 até dezembro de 2010 foi\ud realizada em nossa coorte de 599 pacientes HIV positivos. O desfecho\ud primário foi a ocorrência de TB ativa, e 41 casos da doença foram\ud diagnosticados durante este período de 16 anos. As contagens médias\ud do nadir de células T CD4 e ao momento do diagnóstico de TB foram\ud de 146 e 217 células/mm3, respectivamente. A carga viral média de HIV\ud foi de 5,19 log10 cópias/mL, e 59% dos pacientes estavam em tratamento\ud com ART. A incidência de TB foi de 1,47 casos por 100 pessoas-ano,\ud para um tempo total de seguimento da coorte de 2775 pessoas-ano.\ud A probabilidade de sobreviver até 10 anos após o diagnóstico foi de\ud 75% para pacientes com TB, em oposição a 96% para pacientes com\ud outras doenças oportunistas não-TB (p = 0,03). A tuberculose pode ser\ud considerada problema de saúde pública entre as pessoas que vivem\ud com HIV no Brasil, apesar da ampla utilização de anti-retrovirais para o tratamento da infecção pelo HIV / AIDS

Use of doxycycline for leptospirosis after high-risk exposure in São Paulo, Brazil

A clinical trial pilot study, double-blinded, randomized, and controlled with a placebo to assess the effectiveness of oral doxycycline (200 mg, single dose) in preventing leptospirosis after high exposure to potentially contamined water was performed in São Paulo, SP, Brazil. Confirmed cases were defined as those with leptospira IgM antibody and symptoms; asymptomatic cases were those presenting with IgM antibodies but no symptoms; and suspected cases were individuals with symptoms but no IgM antibody. Forty subjects were given doxycycline and 42 were given placebo. In the drug-treated group there were 2 confirmed cases, 11 asymptomatic cases, and 6 suspected cases. In the placebo group there were 5 confirmed, 6 symptomatic, and 5 suspected cases. Even though we found a protective association of doxycycline for confirmed leptospirosis cases (RR = 2.3) and seroconversion only (RR = 2.0), the association was not statistically significant because of the small number of individuals enrolled in this pilot study. We observed that the 22% of the volunteers already had IgM antibodies to leptospirosis at the first sampling. Finally, the attack rate to confirmed, asymptomatic, and suspected cases of Leptospirosis was 8.5%, 22%, and 13%, respectively, in this population.<br>Um ensaio clínico, duplo-cego, ao acaso, e controlado com placebo para aferir a eficácia da doxiciclina (200 mg, dose única) em prevenir leptospirose após exposição de alto risco com água potencialmente contaminada foi realizado em São Paulo, SP, Brasil. Casos confirmados foram definidos como aqueles que apresentavam anticorpos IgM anti-Leptospira e sintomas; casos assintomáticos eram aqueles que apresentavam somente anticorpo IgM, casos suspeitos apresentavam sintomas, porém sem anticorpo IgM. 40 indivíduos tomaram doxaciclina e 42 tomaram placebo. No grupo tratado houve 2 casos confirmados, 11 assintomáticos e 6 casos suspeitos. No grupo placebo houve 5 casos confirmados, 6 assintomáticos e 5 casos suspeitos. Apesar de haver uma associação protetora da doxaciclina nos casos confirmados (RR = 2,3) e soroconversão (RR = 2,0), a associação não foi estatisticamente significante devido ao pequeno número de indivíduos envolvidos no estudo. Foi observado que a taxa de ataque de casos confirmados, casos assintomáticos e casos suspeitos de leptospirose foi 8,5%, 22%, e 13%, nessa população